ISSUES - GENERAL: Ireland is a country with inward and outward migration of health and social care workers. The health services in Ireland operate in a competitive global market for skilled healthcare workers. There is significant demand for Irish healthcare internationally. - EMIGRATION: Ireland does not maintain a central register of those emigrating, however, there is evidence of increased mobility internationally (to other countries) of Irish registered/Irish trained professionals post pandemic. Research by the Central Statistics Office (CSO) and National Doctors Training Programme (NDTP) in the Health Service Executive (HSE) shows that a high proportion of emigrating doctors and nurses return to Ireland. - DOMESTIC STUDENTS STUDYING ABROAD: There are challenges with some Irish students studying abroad and not having the required competencies on return to gain registration. - ACCESS TO DOMESTIC STAFF: Stakeholders in the public and voluntary sector reported challenges accessing staff. Voluntary organisations also noted high care staff vacancy levels. - DOMESTIC SUPPLY: It takes many years to train new health and social care workers, recruiting them from abroad can provide a solution to address immediate shortages. - VISA PROCESS: Stakeholders reported that visa requirements can delay the recruitment process, as and a timeframe is required for processing. Some professions are not eligible for the Critical Skills Employment Permit - DATA: It is difficult to assess the scale of emigration as there is no central register, and for many professions, data on this is not currently collected by regulators. The country where workforce is emigrating from can at best capture “intent of emigration due to work” but this can only be captured by the countries these workforces are emigrating towards. MEASURES TO ADDRESS ISSUES - Ireland is seeking to improve self-sufficiency in accordance with our commitments under the WHO Global Code of Practice on the International Recruitment of Health Personnel. - BUILD STUDENT SUPPLY: Work is underway to expand the number of health and social care worker student places. - ATTRACT/ RETAIN EFFORTS: The Department of Health and the Health Service Executive work together to develop strategies that will positively impact recruitment and retention, including addressing issues such as workload, work–life balance, workplace culture, supportive management, career advancement and workplace safety. Examples of recently developed strategies that will be/are being implemented include the Health Service Executive (HSE) Resourcing Strategy, the Report of the Expert Review Body on Nursing and Midwifery, the Non-Consultant Hospital Doctor (NCHD) Taskforce Interim and Final Reports, the Report of the Strategic Workforce Advisory Group and Sharing the Vision. The primary pillar of the HSE Resourcing Strategy ‘Resourcing our Future’ is the retention of staff. From 2022 onwards there has been a steady increase in retention levels which is demonstrated by the recent turnover figures. This pattern is continuing in 2024. Within the Expert Review Body on Nursing and Midwifery, four recommendations are specifically focused on attracting, recruiting and retaining nurses and midwives and these recommendations are being led out by the HSE National HR Office as part of the implementation plan. - JOB OFFERS FOR GRADUATES: Retention of health care graduates has been at the forefront of resourcing for the public service over the last number of years, this has resulted in each HSCP and Nursing and Midwifery graduate getting offered permanent contracts of employment. In 2023 alone this has resulted in 83% of our nursing and midwifery graduates taking permanent positions in the publicly funded health services. Voluntary services also reported offering graduate positions/programmes. - EFFORTS TO ATTRACT DOMESTIC WORKERS TO IRELAND: The HSE works very closely with the regulators to attract both those trained in Ireland and overseas. An example of this was a partnership marketing campaign with CORU (regulator for Health & Social Care Professionals) to attract Irish applicants back to Ireland. - UNDERSTANDING MIGRATION PATTERNS: Recent research has been undertaken to better understand migration patterns. For example analysis by the Central Statistics Office on health graduates, and the National Doctors Training and Planning in the HSE on trainee doctors leaving the Irish health system and the numbers returning.

ISSUES - Feedback from across the sector reports a reliance on international recruitment of health personnel to meet domestic needs. - PROPORTION: The proportion of foreign trained doctors and nurses has been increasing over the past number of years. In 2023, 52% of nurses and 43% of doctors were foreign educated. The percentage of foreign trained doctors rose by 2.91% between 2021 and 2023. The percentage of foreign trained nurses rose by 5.28% between 2021 and 2023. - INCREASING RELIANCE: Stakeholders reported that there is increasing pressure to recruit from overseas across the public, private and voluntary sectors. This is due to a number of reasons including: o Increased investment in the public health service and the associated requirement to recruit additional staff. o Increased outflows of staff post pandemic to other jurisdictions. o Implementation of various policies that required additional staff. o Requirement to source some staff/professions from the international market that previously were available in the Irish labour market. - CHALLENGES ACCESSING STAFF: Public and voluntary organisations reported challenges accessing domestic staff. This can often result in vacancy rates and agency use. Voluntary organization stakeholders reported a greater chance of retaining international staff for longer periods as their work permits are tied to their employment thereby impacting their mobility within the domestic labour market. The costs of international recruitment were reported as better value for money than paying agency placement fees locally for staff who may be unlikely to retain in the longer term. However, under the Employment Permits Acts 2024, to be commenced in the coming weeks, subject to certain conditions, a permit holder may change to a similar role with a new employer for any reason, after a prescribed period of nine months. MEASURES TO ADDRESS ISSUES - Ireland is seeking to improve self-sufficiency in accordance with our commitments under the WHO Global Code of Practice on the International Recruitment of Health Personnel. - BUILD STUDENT SUPPLY: Work is underway to expand the number of health and social care worker student places. - EXPANDING ENTRY: The Department of Health and stakeholders are examining the scope to develop non-traditional career pathways, including expanded application of Apprenticeships and earn as your learn models The public health service is currently expanding the routes of entry to the register for some professions via the introduction of apprenticeships – commencing with social work in 2024. - INTERNATIONAL RECRUITMENT: International recruitment is carried out in line with the WHO Code of Practice. - MODELLING: There are modelling activities underway by the Department of Health, HSE and ESRI which provide projections of workforce demand and supply. Outputs from these modelling tools informs workforce planning activities.

Suggest that some questions could be simplified/ clarified. Some were misinterpreted by stakeholders when responding